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Showing posts from September, 2010

Patient Reported Outcome Measures (PROMs)

There is increasing recognition on the importance of measuring outcomes in health care. One method of doing this is through the use of Patient Reported Outcome Measures (PROMs). These are indicators that measure quality from the patient perspective. A recent letter published in the British Medical Journal discussed the role of PROMs in promoting equity of access to elective health care. Preoperative measurement of PROMS, which is now routine for some NHS-funded procedures, can provide information about perceived needs and how this varies across referred populations by deprivation score or other socio-demographic factors. We already know that for some interventions, including hip replacement, postoperative improvement is strongly associated with preoperative PROM disease severity. This is demonstrated by data from the English hip replacement audit in the figure above. Using PROMs as part of an intervention threshold in elective surgery could improve both equity and efficiency, and thei…

Amputations in people with diabetes

Diabetic foot lesions remain a considerable cause of ill-health and a leading cause of hospitalization in people with diabetes. Unfortunately, despite intensive self-care and NHS treatment, many people with diabetes will eventually reach the stage when they need an amputation. Undergoing an amputation has a major social and psychological impact on patients, as well as considerable financial costs for health systems. In a recent study published in the journal Diabetes Care, Eszter Vamos and colleagues examined time trends in rates of amputation in people with diabetes aged over 16 years between 2004 and 2008 using national hospital activity from data from all NHS hospitals in England. They found an increase in the number of people with diabetes undergoing amputations. This was largely due to the increased prevalence (i.e. increased number of patients) with diabetes.  The findings illustrate the need to continue to improve the quality of care of people with diabetes to reduce the risk o…

Implementation of the NHS Health Checks programme

National Health Service Health Checks is a population-wide primary prevention programme for cardiovascular disease in England. The Department of Health began to implement the programme nationally in April 2009. The programme is delivered locally by primary health care teams and involves offering a ‘health check’ to all persons aged 40–74 years without diagnosed cardiovascular disease or diabetes. The health check includes measurement of body mass index (BMI), blood pressure, smoking status and lipid levels.

A recent paper published in the journal Family Practice examined the current level of risk factor recording in one part of London and how this varied with patient characteristics. The study also sought to quantify the likely workload for primary care teams in England of the new Health Checks programme. The study found that the recording of smoking status and blood pressure was very high in the electronic medical records of people without existing cardiovascular disease or diabetes.…

The Imperial College Obesity Strategy Assessment Framework (IC-OSAF)

Obesity is a major public health issue because of its increasing prevalence and impact on health. For example, as well as its impact on conditions such as high blood pressure and coronary heart disease, obesity is now also an important risk factor for cancer and liver dieases. The management of overweight and obesity has therefore been a government priority for many years. However, overweight and obesity management at a local level has often been ineffective. Although there is a need to examine obesity strategies and policies for local populations, there is currently no readily available framework for evaluating local obesity strategies. Researchers at Imperial College, led by Nik Tuah, therefore developed a framework, the Imperial College Obesity Strategy Assessment Framework (IC-OSAF), for examining the content of local obesity strategies.

The IC-OSAF was developed by adapting two previous policy analysis frameworks (Bardach’s Eightfold Path Framework and Collins’ Health Policy Anal…